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«Query: To what degree has behavioural economics and, in particular, the concept of 'nudging' been understood and used in development interventions to ...»

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 information regarding the need to change  motivation to change behaviour  skills to initiate and sustain new behaviour  technical skills  social skills  feeling that change is possible  supportive changes in community norms  policy structure changes to support educational efforts and behaviour changes In their review of social marketing campaigns Stead and colleagues (2009) found a number of key points that characterised successful social marketing initiatives that

can be used as a checklist to ensure best practice:

1. Changing attitudes, behaviour and policy requires a long-term commitment with long-lasting organisational and financial support.

2. Many social and public health issues are a challenge for society as a whole, not just a group of individuals. Adopting a perspective that facilitates policy change as well as individual behaviour change encourages broad ownership of a problem and collective responsibility for tackling it.

3. Reframing a problem can be effective. For example, the ban on smoking in public places was achieved because the problem moved away from ‗victim blaming‘ towards a public health issue – the protection of workers.

4. Offerings showing humour, empathy and positive messages can engage people‘s emotions as effectively as fear-based messages.

5. They often involve multiple approaches including upstream changes to policy and services as well as awareness-raising, education, legislation and continued support for behaviour change.

6. Changing behaviour often means changing social norms because changing the way the public sees a problem can increase buy-in and encourages greater self reflection.

7. They are built on understanding the target group‘s attitudes, values and needs.

8. They analyse and address the ―competition‖ to the desired behaviour or policy change.

Nudge smudge: UK Government misrepresents “nudge” Chris Bonell, Martin McKee, Adam Fletcher, Andrew Haines, Paul Wilkinson, The Lancet, 17th January 2011 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60063-9/fulltext This paper argues that the government has misrepresented nudging as being in opposition to their use of regulation and legislation to promote health, and that this misrepresentation serves to obscure the government‘s failure to propose realistic actions to address the upstream socioeconomic and environmental determinants of disease.

Nudging largely ignores the socioeconomic determinants of behaviour. Rather than combating poverty and injustice, nudgers can only hope to compensate by nudging people who are poor more vigorously. But how can one nudge away the poor lifechances of children living in poverty, the societal harms arising from income inequality, or the obesogenic effects of the excessive use of fossil fuels? How could nudges have combated cholera from poor hygiene in the 19th century or respiratory disease from pollution in the 20th century?

One nudge forward, two steps back: Why nudging might make for muddled public health and wasted resources Bonell, C, McKee, M, Fletcher, A, Wilkinson, P and Haines, A, BMJ 2011, Published 25 January 2011 http://www.bmj.com/content/342/bmj.d401 Despite the fanfares with which nudging has been presented in the recent public health white paper Healthy Lives, Healthy People, these ideas are far from new. In terms of public health science, the notion of nudging adds nothing to existing approaches. Public health policies should be based on the best available evidence, but the government has shown a worrying tendency to undermine the collection of such evidence—for example, by stopping the National Institute for Health and Clinical Excellence from undertaking appraisals of several strategies to improve public health. Nudge contains some eye catching ideas, but little progress will be made if public health policy is made largely on the basis of ideology and ill defined notions that fail to deal with the range of barriers to healthy living.

Is nudge an effective public health strategy to tackle obesity? No http://www.bmj.com/content/342/bmj.d2177 Adam Oliver (doi:10.1136/bmj.d2168) maintains that nudges may help people to make healthier choices, but Geof Rayner and Tim Lang worry that government proposals are little more than publicly endorsed marketing Over the past decade a common picture on the aetiology of obesity has become largely agreed. After years of competing analyses, most people now accept that obesity is the result of a complex multifactoral interplay. It is not either food intake or physical activity but both. It is not just food oversupply or pricing or domestic culture or food marketing or poor consumer choice or genetic potential. In fact, it is all of these and more. At last, scientific advisers have accepted that they have an analysis to share with politicians and can begin the tortuous process of crafting frameworks for action.

So why is the British government quietly breaking with this consensus and putting so much weight behind nudge thinking?

Is nudge an effective public health strategy to tackle obesity? Yes http://www.bmj.com/content/342/bmj.d2168 Adam Oliver maintains that nudges may help people to make healthier choices, but Geof Rayner and Tim Lang (doi:10.1136/bmj.d2177) worry that government proposals are little more than publicly endorsed marketing.

The ―nudge‖ or, more formally, libertarian paternalist agenda has captured the imagination of at least some of the British policy elite, epitomised by the creation of the Cabinet Office‘s behavioural insights team (the so called nudge unit). The reason for the political popularity of nudging is obvious: it offers politicians a tool by which they can offer guidance, without enforcement, on individual behaviour change that is good for and, on reflection, preferred by, individuals themselves. Various nudge policies have been proposed to tackle obesity.

The essence of the approach is to apply behavioural economic insights (for example, loss aversion—that losses tend to ―hurt‖ more than gains of the same size) to policy considerations so as to change the choice architecture.

Building grass roots capacity to tackle childhood obesity Sim, F., Ahmad, R., 2011, Perspectives in Public Health 131 (4), pp. 165-169 http://www.scopus.com/record/display.url?eid=2-s2.0origin=resultslist&sort=plf-f&cite=2-s2.0src=s&imp=t&sid=kbJ1nNoRXSzTEa_bRN6NFOt%3a160&sot=cite& sdt=a&sl=0&relpos=2&relpos=2&searchTerm= The programme, based on best available evidence and clear evidence of needs, provides a low-cost evaluated intervention that permits people from diverse professional and occupational backgrounds to acquire the knowledge, skills and confidence needed to raise the subject of healthy and unhealthy weight with parents of primary school-aged children.

Nudge or Fudge Jacqui Wise, BMJ 2011; 342, Published 27 January 2011 http://www.bmj.com/content/342/bmj.d580 Nudging the general population into healthier lifestyles does have a role to play but should not be the sole approach that the government uses to tackle health inequalities, public health and social care experts agreed.

Changing health-risk behaviours: a review of theory and evidence-based interventions in health psychology Adriana BĂBAN, Catrinel CRĂCIUN, Babeş-Bolyai University, Cluj-Napoca, Romania, Vol VII, No. 1, 2007 http://jcbp.psychotherapy.ro/vol7no1/changing-health-risk-behaviors-a-review-oftheory-and-evidence-based-interventions-in-health-psychology/ Changing health-risk behaviour has been shown to decrease morbidity and mortality and enhance quality of life. The present review aims to describe the models and theories that underpin effective interventions and the empirical studies that warrant their successful use with specific health risk-behaviours. Motivational, behavioural enactment and multi-stage models are critically discussed in the context of identifying the ingredients that help translate theories into practice by designing effective behaviour change interventions. Future research directions are outlined for continuing the development of a theory and evidence based practice in health psychology and its integration with evidence-based theory and practice of cognitivebehavioural psychotherapies, as both are focused on behavioural change.

6. How has its impact been measured?

One nudge forward, two steps back: Why nudging might make for muddled public health and wasted resources Bonell, C, McKee, M, Fletcher, A, Wilkinson, P and Haines, A, BMJ 2011, Published 25 January 2011 http://www.bmj.com/content/342/bmj.d401 This article considers the vagueness with which the term nudge has been used, its limited evidence base, and its potential for harm. They call for new primary research and systematic reviews to examine the effectiveness of public health nudges.

Discounting future green: money versus the environment.

David J. Hardisty and Elke U. Weber, Journal of Experimental Psychology 138(3):

329-340, 2009 http://www.apa.org/pubs/journals/releases/xge1383329.pdf In 3 studies, participants made choices between hypothetical financial, environmental, and health gains and losses that took effect either immediately or with a delay of 1 or 10 years. In all 3 domains, choices indicated that gains were discounted more than losses. There were no significant differences in the discounting of monetary and environmental outcomes, but health gains were discounted more and health losses were discounted less than gains or losses in the other 2 domains. Correlations between implicit discount rates for these different choices suggest that discount rates are influenced more by the valence of outcomes (gains vs. losses) than by domain (money, environment, or health). Overall, results indicate that when controlling as many factors as possible, at short to medium delays, environmental outcomes are discounted in a similar way to financial outcomes, which is good news for researchers and policy makers alike.

Is There a Right Way to Nudge? The Practice and Ethics of Choice Architecture Selinger, E., Whyte, K., 2011, Sociology Compass 5 (10), pp. 923-935 http://onlinelibrary.wiley.com/doi/10.1111/j.1751-9020.2011.00413.x/abstract Cass Sunstein and Richard Thaler‘s Nudge: Improving Decisions about Health, Wealth, and Happiness presents an influential account of why ‗choice architecture‘ should be used to ‗nudge‘ people into making better decisions than they would otherwise make. In this essay we: (1) explain the main concepts that Thaler and Sunstein rely upon to defend their project; (2) clarify the main conceptual problems that have arisen in discussions about nudges; (3) clarify practical difficulties that can arise during nudge practice; (4) review the main ethical and political objections that have been raised against nudging; and (5) clarify why issues related to meaning can pose methodological problems for creating effective choice architecture.

BMJ Poll http://www.bmj.com/about-bmj/poll-archive The British Medical Journal polled readers as to whether ‗nudge‘ could effectively tackle obesity: 66% said no.

BMJ Comments http://www.bmj.com/content/342/bmj.d401?tab=responses The pattern of consumer purchases.

Ehrenberg ASC., Applied Statistics,1959; 8(1):26-41.

http://www.jstor.org/stable/pdfplus/2985810.pdf?acceptTC=true An early article on human behaviour The New Paternalism –Unravelling „Nudge‟ Glen Whitman, Economic Affairs, 2011 http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0270.2011.02115_3.x/pdf For many years, people have been telling other people what is good for them – and manipulating or forcing them to do it. Today the ‗new paternalism‘ seeks to make people better off by their own standards.

New paternalism has many names, and arose from behavioural economics, which studies how people deviate from the pure rationality of mainstream economics. Real people have cognitive biases, including lack of self-control, excessive optimism, status quo bias, and susceptibility to framing of decisions. The new paternalism is informing policy in Downing Street which has a ‗nudge‘ unit to try to find subtle ways of changing our behaviours in ways government feels are best for us. The proposals of the new paternalism might seem modest. But, if you dig deeper, you will find a wide-ranging policy agenda at work. In articles by the main academics working in the field, you will find policy proposals from mild to downright intrusive. New paternalists present their position as the reasonable middle ground between rigid antipaternalism and intrusive ‗hard‘ paternalism. However, it carries a risk of placing us on a slippery slope from soft paternalism to hard. The slippery slope risk must be counted among the relevant costs of new paternalist policies.

Real people are susceptible to cognitive biases that can lead to poor decisions. But no one is immune to bias. The same cognitive defects that they wish to correct by ‗nudging‘ also exist amongst politicians. I recommend a slope-resisting framework – one that stresses private options and opportunities for self-correction. That doesn‘t mean we will never adopt any new paternalist policies but we will hopefully stand a better chance of not slipping down the slope.

Nudging Gender Bias in the Workplace Harvard Kennedy School http://www.hks.harvard.edu/news-events/publications/impactnewsletter/archives/summer-2011/nudging-gender-bias-in-the-workplace Organising a group of ―evaluators‖ and ―candidates‖ at the Harvard Decision Science Laboratory, the authors conducted their study to determine whether gender bias exists in the evaluation of professional candidates. They found that when assessing candidates individually, the interviewers were much more likely to base their decisions on a candidate‘s gender. Male candidates were preferred for mathematical tasks, while female candidates were preferred for verbal tasks, regardless of how the candidate had performed in the past. However, when a man and a woman were evaluated at the same time, the interviewers were more concerned with their past performance than with their gender.

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